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British Journal of General Practice, October 2016 529
delay. Put aside time to share these feelings
with a trusted colleague, a loved one, or
your GP. Reflect on where this is heading if
things don’t change. Early recognition and
an action plan may restore your happiness
and relationships, enable you to avoid
complaints, and even save your career. If you
don’t act it will probably get worse, so don’t
wait until you reach the point of no return.
Simon Tobin,
GP, Southport.
Neal Maskrey,
Visiting Professor of Evidence-Informed Decision
Making, Keele University, Keele.
Acknowledgements
The authors are grateful to the members of the
RCGP’s overdiagnosis e-mail discussion group for
their comments and advice on earlier drafts of this
paper.
DOI:10.3399/bjgp16X687385
ADDRESS FOR CORRESPONDENCE
Simon Tobin
Norwood Surgery, 11 Norwood Avenue, Southport,
PR9 7EG, UK..
E-mail: simon.tobin@gp-n84008.nhs.uk
REFERENCES
1. Hobbs FDR, Bankhead C, Muktar T,
et
al
. Clinical workload in UK primary care:
a retrospective analysis of 100 million
consultations in England, 2007–14.
Lancet
2016;
387(10035): 2323–2330.
2. Royal College of General Practitioners.
A blueprint for building the new deal for
general practice in England
. London: RCGP,
2015. http://www.rcgp.org.uk/~/media/Files/
PPF/A-Blueprint-for-building-the-new-deal-for-
general-practice-in-England.ashx (accessed 2
Sep 2016).
3. Precey M. English GP surgeries reach
new patient ‘breaking point’.
BBC News
2016; 6 Jan: http://www.bbc.co.uk/news/
uk-england-35200033 (accessed 2 Sep 2016).
4. Lehman R. Richard Lehman’s journal review
— 3 January 2012. http://blogs.bmj.com/
bmj/2012/01/03/richard-lehmans-journal-
review-3-january-2012/ (accessed 2 Sep 2016).
5. Lehman R, Tejani AM, McCormack J,
et al
.
Ten Commandments for patient-centred
treatment.
Br J Gen Pract
2015; DOI: 10.3399/
bjgp15X687001.
6. Haslam DA. Who cares? The James Mackenzie
Lecture 2006.
Br J Gen Pract
2007; 57(545):
987–993.
7. McCartney M. Coffee time is about much more
than coffee.
BMJ
2014; 348: g3444.
Books
Out of Hours
Painkiller Addict: From Wreckage to
Redemption — My True Story
Cathryn Kemp
Little, Brown Book Group, 2012, PB, 320pp,
£13.99, 978-0749958060
NEVER ENOUGH
As a GP trainee, I find opioid prescribing a
particular challenge. This is especially the
case for patients with chronic pain, where
the distinction between analgesia and
addiction can become increasingly blurred.
It can be extremely difficult to maintain a
therapeutic relationship with a patient who
is dependent on the painkillers that they are
being prescribed.
In her book
Painkiller Addict: From
Wreckage to Redemption,
author Cathryn
Kemp chronicles her own descent into
fentanyl addiction, and her harrowing
journey through recovery.
Previously a successful journalist, Kemp
was diagnosed with idiopathic pancreatitis,
and spent more than 2 years in and out of
hospital. She was eventually discharged to
the care of her GP with chronic abdominal
pain and a prescription for fentanyl
lozenges. Kemp initially adhered to the
prescribed dose of eight lozenges per day,
until a difficult break-up triggered her to
think
‘one more won’t hurt …’
This book provides a brutally honest
account of Kemp’s escalating use of fentanyl,
peaking at 60 lozenges every day. It is a vivid
depiction of how addiction insidiously grows
to dominate every realm of a person’s life,
and how the ravages of withdrawal are a
terrifying, ever-present threat. Kemp says,
‘there never seems to be the feeling that I’ve
had enough. I am always wanting the next
lozenge. The craving follows me around all
the time, like a lost puppy.’
Kemp describes an increasingly fraught
relationship with her GP, whom she calls her
‘dealer’. Her GP attempts to limit the lozenge
prescription on many occasions, giving the
reader a unique insight into the patient
perspective of the classic ‘drug-seeking’
interaction:
‘I nod with a compliant smile. He
signs my prescriptions. I’ll do anything, agree
to anything, as long as he carries on signing.’
Painkiller Addict: From Wreckage
to Redemption
provides a gripping and
realistic narrative of prescription medication
addiction, and I was left with a much better
understanding of why those addicted to
painkillers behave as they do.
Abbey Gray,
GPST SE Scotland, Edinburgh.
E-mail: abbey.gray87@gmail.com
DOI: 10.3399/bjgp16X687397
* * * * *
Stressed, Unstressed: Classic Poems to
Ease the Mind
Edited By Jonathan Bate, Paula Byrne,
Sophie Ratcliffe, and Andrew Schuman
HarperCollins, 2016, HB, 224pp, £14.99,
978-0008164508
CAN YOU BE RE-LIT BY POETRY?
This recently published volume is an
anthology of new and old poems — some
familiar and some less so, but all chosen
by the editors, who include an NHS GP,
to
‘speak to us when we are processing
worries or when we simply want to fill
our minds with different, more positive
thoughts’
. The book is designed to serve
as an introduction to the ancient art of
‘bibliotherapy’: reading for wellbeing. Does
it succeed in its stated intent? The short
answer is yes. How does it do this?
The book itself is divided into 12 sections,
each of which contains a number of
poems chosen to address some of our
most troubling moods such as ‘grieving’ or
‘feeling alone’.
One of the most powerful suggestions
in the book is its encouragement to read
the poems aloud and immerse yourself in
its words. This harnesses the power not
only of the words themselves but also of
your own imagination. Recent findings from
neuroscience support this — FMR scans
show that the simple act of just imagining
compassion activates the soothing and
affiliation component of the emotion
regulation system of the brain.1
The poems are well chosen to illustrate
alternatives to our present mood. An
afterword by Mark Williams linking the use
of the book to the practice of mindfulness is a
very satisfying coda to the whole experience.
All proceeds from the sales will be
donated to ReLit, the campaign to alleviate
stress and other mental health conditions
through mindful reading. All doctors and
patients can benefit from ‘dipping into’ this
book and I recommend it for all of us who
are facing difficult times during the current
GP workload crisis. Every waiting room
should have a copy.
http://www.relit.org.uk/
Nigel Mathers,
Head of Academic Unit of Primary Medical
Care, University of Sheffield, Samuel Fox House,
Northern General Hospital, Herries Road, Sheffield;
RCGP Honorary Secretary, RCGP, London.
E-mail: n.mathers@sheffield.ac.uk
DOI: 10.3399/bjgp16X687409
When Someone You Know Has
Depression: Words to Say and Things to Do
Susan J Noonan
Johns Hopkins University Press, 2016, PB,
160pp, £11.00, 978-1421420158
RECOVERY AND RESILIENCE
Susan Noonan is a US physician and peer
specialist, who has lived experience of
depression. In this brief and accessible text
she provides a wealth of practical information
to enable family and friends to offer help to
someone who is depressed. Beginning with
the epidemiology of depression, she goes
on to describe symptoms and signs, and
then provides valuable advice on supportive
communication strategies, mental health
first aid, and when and how to enlist
professional help. There are particularly
useful sections on warning signs for suicide,
setting boundaries and maintaining one’s
own personal space, and how to anticipate
recovery and build resilience.
Interspersed with the text, Noonan
provides a set of charts and tables for use
by family and friends. Some of the tables,
for instance on pleasurable activities or
sleep hygiene, could be a useful resource
during GP consultations.
I do have some concerns. The list of
resources given at the end of the book is
US-based and would need to be amended
for use in the UK and other countries.
Noonan has a more biological and genetic
orientation to depression than is warranted
by existing evidence.
Her argument for the underdiagnosis
of depression in men is debatable and is
not balanced by discussion of the problems
of overdiagnosis. I am unconvinced of
the benefits of asking patients to keep a
daily mood chart, as this runs the risk of
encouraging preoccupation with mental
symptoms.
With these caveats, I would recommend
this book to family members and friends
of patients who are living with severe,
recurrent, or long-term depressive
disorders, as a companion to my own
introduction for children.1 And as well as
inviting my patients to read my own blog,
well becoming
, I will now suggest they also
follow Noonan’s
View from the Mist
.
Christopher Dowrick,
Professor of Primary Medical Care, Institute of
Psychology, Health and Society, University of
Liverpool, Liverpool.
E-mail: cfd@liv.ac.uk
DOI: 10.3399/bjgp16X687421
530 British Journal of General Practice, October 2016
REFERENCE
1. Gilbert P, Choden.
Mindful compassion.
London: Constable, 2013.
REFERENCE
1. Dowrick C, Martin S.
Can I tell you about
depression?
London: Jessica Kingsley
Publishers, 2015.
